title: A historical perspective of pacemaker infections: 40-years single-centre experience.
abstract: OBJECTIVE
  The approach to infected cardiac devices has changed during recent decades. Optimal treatment is still a matter of debate, especially in pacemaker-dependent patients. Therefore, we investigated the management and outcome of patients with pacemaker infections in a single centre over four decades.
  
  
  RESULTS
  We conducted a retrospective analysis of 4212 patients and extracted those with pacemaker infections admitted to Rostock Heart Center between 1973 and 2012. One hundred and thirty-one consecutive patients (median age 69.6 ± 14.9 years) were admitted for device infections. Two-stage exchange was performed in 42 patients (32.8%). In 72 patients (55%), explantation and implantation on the contralateral side was performed simultaneously. In 17 cases the device was not replaced. Mean follow-up was 63 ± 81 months. Reinfection rate was 12.2%, which declined from 24% (1980s) to 2.6% (after 2000). Complete device removal (in 57.3%) reduced the risk for reinfection by 75% (P = 0.02), as well as increasing age (0.049% per year, P = 0.001). One-stage exchange increased the risk of reinfection six-fold (P = 0.021). Cultured bacteria after initiation of antibiotic therapy predicted a four-fold increase in risk of a recurrent infection (P = 0.01).
  
  
  CONCLUSIONS
  Continuous assimilation of guidelines for pacemaker infection improved the outcome over time: complete extraction of the infected device seems to be highly desirable. A one-stage exchange increased the risk of recurrent device infection and should probably be avoided, but complete extraction seems to be more important than timing.
authors.affiliation: Heart Center, University Hospital of Rostock, Ernst-Heydemann-Street 6, Rostock 18057, Germany.
authors.forename: Tina S
authors.initials: TS
authors.lastname: Tischer
authors.forename: Anne
authors.initials: A
authors.lastname: Hollstein
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Voss
authors.forename: Imke
authors.initials: I
authors.lastname: Wendig
authors.forename: Jörg
authors.initials: J
authors.lastname: Lauschke
authors.forename: Ralph
authors.initials: R
authors.lastname: Schneider
authors.forename: Georg H
authors.initials: GH
authors.lastname: von Knorre
authors.forename: Dietmar
authors.initials: D
authors.lastname: Bänsch
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D020878:Device Removal; D005260:Female; D005858:Germany; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D017410:Practice Guidelines as Topic; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000266:history / Q000382:microbiology* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Device exchange; One-stage-procedure; Pacemaker; Reinfection